About IBA

Identification: using a validated screening tool to identify ‘risky’ drinking, such as the AUDIT

Brief Advice: the delivery of short, structured ‘brief advice’ aimed at encouraging a risky drinker to reduce their consumption to lower risk levels

IBA should be initiated by front line health and social care roles wherever they have a good opportunity, and NOT based on a suspicion of heavy drinking. It is a prevention not a treatment approach to helping at-risk drinkers make an informed choice about their drinking.

As many as one in four adults in England drink at a level that could be harmful to their heath. Most will be suitable for IBA and not require anything further. IBA is a short intervention aimed at motivating at-risk drinkers to reduce their alcohol use. However those ‘Identified’ as possibly alcohol dependent should be offered referral to treatment services.

IBA as a short, effective behaviour change intervention is also commonly known as ‘brief intervention’. However use of the term ‘brief interventions’ tends to include the option of a more ‘extended’ brief intervention approach than IBA tends to infer. The research literature often refers to ‘Screening and Brief Interventions’ (SBI), or often in the U.S as ‘SBIRT’ (Screening and Brief Interventions and Referral to Treatment).

IBA is essentially the delivery of short simple brief advice following Identification (i.e screening) not usually lasting longer than 5-10 minutes. Extended ‘brief intervention’ approaches may last more like 20 minutes and integrate brief motivational interviewing techniques.

IBA however is most likely all that is required in most cases where an ‘at-risk’ drinker will be responsive. IBA is therefore the most simple, cost-effective approach to reducing risky but non dependent drinking at an individual level. IBA is straightforward and is easily learnt by general healthcare workers or other non-alcohol specialists.

Who is IBA for?

IBA is intended for risky drinkers – those who drink at increasing or higher risk levels but are not alcohol dependent. There is some discussion about whether IBA can work for dependent drinkers. Either way, dependent drinkers only make up around 4% of the adult population, whereas around 20% drink at a risky level and are therefore suited to IBA.

The ‘IBA’ controversy – is it really ‘advice’?

IBA has taken over as the common term for screening and brief interventions, but many experts are not happy about this. Mainly the issue is that ‘Brief Advice’ suggests that it is the practitioner’s role to ‘advise’ their clients about alcohol use and cutting down. This isn’t entirely true – IBA is based on the principles of Motivational Interviewing (MI), which are clear that clients should be encouraged to make their own decisions. A practitioner who is advising, rather than guiding, is in danger or eliciting defensiveness which can be counter-productive.

Good IBA is about not ‘advising’ too much, if at all, and encouraging individuals to identify any changes they may wish to make themselves. For instance, instead of saying to a risky drinker, “Cutting down will be good for you health”, a more effective approach would be to ask “Can you think of any benefits you might get from cutting down?”, and offering suggestions or information if needed. Listening skills are very important, and allow the individual to reflect and explore their ideas. Good IBA training will ensure those learning to deliver IBA understand key principles and explore them through skills practice.

Less is more?

Following the recent SIPS findings, there is some recognition that in many cases, simply providing feedback to a risky drinker may be as effective as a longer session of ‘Brief Advice’, or even a longer interaction of ‘brief motivational interviewing’ (extended brief intervention). Although there is variation according to different settings, and all approaches were effective, it can be assumed that the most important thing is for practitioners to ‘Identify’ and give feedback to risky drinkers. However it is crucial they are able to offer further information or referral for those wanting or requiring it, such as those still unsure or with possible dependence.

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